Ramblings of an Emergency Physician in Texas

National Report Card on the State of Emergency Medicine

The American College of Emergency Physicians (ACEP) today released the results of their state-by-state surveys of the State of Emergency Medicine. Most states aren’t going to be happy (and we all knew this when we got an email from the Texas College of Emergency Physicians President telling us not to panic when the grades came out).

Well, they’re out, here. The grading was done on the following categories: Access to Emergency Care, Quality and Patient Safety, Public Health and Injury Prevention, and Medical Liability Environment. Reading any one states’ results will tell you what they were looking for.

Apparently they didn’t find the answers here in my home state of Texas:

Here’s a State by State Comparison of grades. No final grades of A, nor F. Six B’s, which is as high as any state got, and 3 D’s, the lowest score available. There is plenty of room to argue the relative merits of the grading scale (how, exactly, do the numbers of residents and residency programs contribute to Quality and Safety? for instance), but this is an excellent starting point. On the other hand, I doubt any hospital is going to be putting a big poster of this up in their ED waiting rooms.

The point of this exercise is, as I understand it, to bring public (read: lawmaker) attention to the state of your emergency departments. I don’t pretend to know what The Answer is (I suspect it’s a lot of little answers), but what we’re doing now for EM access, and funding, is remarkably poor for such a rich country.

And ACEP is to be commended for doing the work to highlight this issue.

First, what do they mean by Quality/Patient Safety: do they mean was the correct workup done or were the right decisions made? How did they evaluate this? etc.

Again, interesting to nnote that in terms of medical liability an A+ was given but everything else was very poor. How does that reflect on what the ER does (Not the correct thing BUT at least they cover their asses form lawsuits?)

I have to agree with IM Doctor – this seems to look at a mishmosh of factors, some of which have little to do directly with ER docs and departments. I don’t think ER docs bear responsibility for immunizations – yeah you can give them in an ER but overall they are better left to PMD’s.

THe report card has little to do with ER physicians and departments, which is stated right up top on the ACEP web site. It is all about hte state’s support of the emergency medical system. Immunizations/public health are important because the sick public shows up at the ER. Sounds simplistic, but while PMDs should be giving and scheduling the immunizaitons, where does the 70 year old with fever and cough usually show up? The ER. In the winter, these types of visits overwhelm many ERs and push them over the edge of capacitiy, essentially removing that ER from being able to help in the event of any OTHER public health crisis, multiple vehicle MVA, or an acutally mass casualty event. Go to the ACEP website and read the details of the different factors.

Part of the idea of the report card, in my mind, was so that local ACEP chapters can use the information to lobby their state lawmakers for support. THEre are so many factors that inhibit the ability for an individual ER phsyician to provide good care to an individual patient that the report card can help identify points of improvement.

CYA as a practice is not good for an individual patient. In states with little or now laws to protect phsyicians from various malpractice issues, CYA is the norm and is frustrating for everyone (patients have longer visits, more radiation, isurance companies and patients get higher bills). THis report card helps identify quickly which states are doing things well and in what areas.

I agree with what you say, Doc Shazam, but the scope of this report seems overly broad to be calling itself “on the State of Emergency Medicine”. In GruntDoc’s comments he notes “The point of this exercise is, as I understand it, to bring public (read: lawmaker) attention to the state of your emergency departments”. Most people will probably think the same when they read it in their USA Today but they will be mistaken, the state of the ED is a small part of the grade.

Much of the report falls into the categories of preventive medicine and health policy. The title of the report leads doctors and patients to expect information on the quality of the care they are giving and receiving in ED’s. The actual report is further-ranging and I suspect will lead to confusion in people who just glance at a headline and see what grade their state got.